Monitoring food and health news -- with particular attention to fads, fallacies and the "obesity" war

Summary of findings to date: Everything you can possibly eat or drink is both bad and good for you

"Let me have men about me that are fat... Yond Cassius has a lean and hungry look ... such men are dangerous." -- Shakespeare

Friday, January 11, 2008

2.5 bottles of wine a week can save your life

Not three? Probable middle-class effect in the results again

People who drink up to almost 2.5 bottles of wine a week have a lower risk of premature death than those who abstain from alcohol, research has suggested. Moderate drinkers are less likely than either teetotallers or heavy drinkers to die of heart disease and other causes, and the protective effect is magnified if they also take plenty of exercise, scientists have found. A weekly consumption of up to 14 drinks --- classified as a glass of wine, a bottle of beer or a single measure of spirits ? offers the greatest health benefits, a 20-year study of almost 12,000 Danish men and women has concluded.

The healthiest were those who were moderate drinkers and moderately or very physically active. Their risk of dying from heart disease was about half that of inactive nondrinkers. Martin Gronbaek, of the University of Southern Denmark in Copenhagen, who led the research, said: "Our study shows that being both physically active and drinking a moderate amount of alcohol is important for lowering the risk of both fatal ischaemic heart disease (IHD) and death from all causes. For both men and women, being physically active was associated with a significantly lower risk for both fatal IHD and all-cause mortality than being physically inactive, and drinking alcohol was associated with a lower risk of fatal IHD than abstaining. "A weekly moderate alcohol intake reduced the risk of all-cause mortality among both men and women, whereas the risk among heavy drinkers was similar to nondrinkers."

In the study, published in the European Heart Journal, a team led by Professor Gronbaek, Berit Heitmann and Jane Ostergaard Pedersen, analysed data collected by the Copenhagen City Heart Study, a long-running research cohort assembled in the 1970s to investigate cardiovascular health.

In the mid1970s, almost 20,000 Danish men and women from the same area of Copenhagen were selected randomly from electoral rolls. About 70 per cent agreed to participate, and 11,914 adults eventually answered detailed questionnaires between 1981 and 1983 about many aspects of their behaviour that were considered possible influences on cardiovascular health, including exercise and drinking habits. The goal was to follow up a large group of ordinary people over a long period to find out whether different behaviours among a people of broadly similar social background were associated with any health effects.

There have been 5,901 deaths, including 1,242 from ischaemic heart disease. Ms Ostergaard Pedersen said: "The lowest risk of death from all causes was observed among the physically active moderate drinkers and the highest risk among the physically inactive non and heavy drinkers."

This is not a strong study methodologically but the differences observed are large and orderly so it would seem to be an argument against "frivolous" caesareans. Journal article here

Waiting a little longer for an elective caesarean may be key to avoiding neonatal respiratory problems in term infants, according to investigators here. Babies delivered by elective caesarean from 37 through 39 weeks carry a two- to fourfold increased risk of overall and serious respiratory morbidity compared with babies delivered vaginally or by emergency caesarean, Anne K. Hansen, M.D., of Aarhus University Hospital, and colleagues, reported in an observational study in BMJ Online. The relative risk in their prospective cohort decreased with even small amounts of increasing gestational age, so that waiting until 39 weeks' gestation halved the 37-week risk, the researchers added. Yet even at 39 weeks an increase in morbidity remained, possibly due to a lack of hormones associated with labor.

If no medical indication is present, the investigators said, evidence-based information about the risks and benefits for mothers and newborns becomes all the more important for adequate counseling.

Respiratory morbidity included transitory tachypnea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn, and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation).

The study included 34,458 live-born singleton babies without birth defects and with gestational ages of 37 to 41 weeks who were born from January 1998 through December 2006 at the Aarhus hospital. In an intention-to-treat methodology, the infants were categorized in two groups, elective caesarean section and intended vaginal delivery (all vaginal deliveries and emergency caesareans). Of these, 2,687 infants (7.8%) were delivered by an elective caesarean. Compared with newborns given intended vaginal delivery, a fourfold increased risk of respiratory morbidity was found for elective caesarean infants delivered at 37 weeks of gestation (OR: 3.9, 95% CI: 2.4 to 6.5). The risks decreased with increasing gestation. At 38 weeks, the risk was three times greater (OR: 3.0, 95% CI: 2.1 to 4.3), and at 39 weeks, the risk was almost double (OR: 1.9, 95% CI: 1.2 to 3.0).

For example, at 37 weeks, 2.8% of infants delivered by intended vaginal delivery had general respiratory problems compared with 10% of those delivered by caesarean. At 38 weeks, the proportion was 1.7% compared with 5.1%, and at 39 weeks it was 1.1% versus 2.1%. The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios than those for general respiratory problems. For elective caesarean at 37 weeks, the researchers reported a fivefold increased respiratory risk (OR: 5.0, 95% CI: 1.6 to 16.0).

These results remained essentially unchanged after exclusion of pregnancies complicated by diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation, they wrote.

The mechanisms behind these findings are not known, the investigators said, but the lack of hormones associated with labor could explain the association. During spontaneous labor there is a decrease in the secretion of fetal lung liquid and an increase in its absorption while the release of surfactant is stimulated. This may be mediated by a raised level of catecholamines in the infant in response to rupture of the membranes and labor. This surge, however, is absent when caesareans are carried out before labor, they wrote.

One study limitation, the researchers noted, was the fact that information on the type of delivery was validated by research midwives before data entry, and information on respiratory problems was provided by neonatologists. However, they said, variation may have existed in the use of the international classification of diseases.

The authors noted that while waiting until 39 weeks of gestation halves the 37-week risk, there may be other consequences. Carrying out elective caesareans at greater gestational ages "may result in higher rates of intrapartum caesareans because some women would go into spontaneous labor (in our population 25% of spontaneous intended vaginal deliveries started before 39 weeks' gestation)," they wrote. "Compared with elective caesarean sections, intrapartum caesarean sections may carry an increased risk of complications such as uterine rupture in women with previous caesarean section, infections, or even maternal mortality."

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

"What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

Where it is not bunk is when it shows that some treatment or influence has no effect on lifespan or disease incidence. It is as convincing as disproof as it is unconvincing as proof. Think about it. As Einstein said: No amount of experimentation can ever prove me right; a single experiment can prove me wrong.

Epidemiological studies are useful for hypothesis-generating or for hypothesis-testing of theories already examined in experimental work but they do not enable causative inferences by themselves

The standard of reasoning that one commonly finds in epidemiological journal articles is akin to the following false syllogism:
Chairs have legs
You have legs
So therefore you are a chair

I am rather in despair that important medical research is plagued by arrant nonsense. The simple truth that correlation is not causation seems unknown to most medical writers. As a last ditch attempt to get that truth into a few more skulls let me be "offensive". Offensiveness may serve to get the matter noticed. So here is the story: There is about a -.5 correlation between lip size and IQ. Big lips predict low IQ. Your run-of-the mill medical researcher will pounce on that as a huge breakthrough in finding the causes of IQ -- and propound new theories about things such as blood circulation to explain how lips affect IQ. But that is nonsense. Big lips are mostly found on people of African ancestry and, as all the studies attest, Africans are a very low IQ group. The correlation arises because of heredity, not lip size. There is a third factor behind the correlation -- and the possibility of such third factors seems to be a jaw-dropping surprise to most medical researchers

SALT -- SALT -- SALT

1). A good example of an epidemiological disproof concerns the dreaded salt (NaCl). We are constantly told that we eat too much salt for good health and must cut back our consumption of it. Yet there is one nation that consumes huge amounts of salt. So do they all die young there? Quite the reverse: Japan has the world's highest concentration of centenarians. Taste Japan's favourite sauce -- soy sauce -- if you want to understand Japanese salt consumption. It's almost solid salt.

2). We need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. So the conventional wisdom is not only wrong. It is positively harmful

3). Table salt is a major source of iodine, which is why salt is normally "iodized" by official decree. Cutting back salt consumption runs the risk of iodine deficiency, with its huge adverse health impacts -- goiter, mental retardation etc. GIVE YOUR BABY PLENTY OF SALTY FOODS -- unless you want to turn it into a cretin

4). Our blood has roughly the same concentration of salt as sea-water so claims that the body cannot handle high levels of salt were always absurd

5). The latest academic study shows that LOW salt in your blood is most likely to lead to heart attacks. See JAMA. 2011;305(17):1777-1785. More here and here and here for similar findings. Salt is harmless but a deficiency of it is not. We need it. See also here

PEANUTS: There is a vaccination against peanut allergy -- peanuts themselves. Give peanut products (e.g. peanut butter -- or the original "Bamba" if you have Israeli contacts) to your baby as soon as it begins to take solid foods and that should immunize it for life. See here and here (scroll down). It's also likely that a mother who eats peanuts while she is lactating may confer some protection on her baby. See here

THE SIDE-EFFECT MANIA. If a drug is shown to have troublesome side-effects, there are always calls for it to be banned or not authorized for use in the first place. But that is insane. ALL drugs have side effects. Even aspirin causes stomach bleeding, for instance -- and paracetamol (acetaminophen) can wreck your liver. If a drug has no side effects, it will have no main effects either. If you want a side-effect-free drug, take a homeopathic remedy. They're just water.

Although I am an atheist, I have never wavered from my view that the New Testament is the best guide to living and I still enjoy reading it. Here is what the apostle Paul says about vegetarians: "For one believeth that he may eat all things: another, who is weak, eateth herbs. Let not him that eateth despise him that eateth not; and let not him which eateth not judge him that eateth." (Romans 14: 2.3). What perfect advice! That is real tolerance: Very different from the dogmatism of the food freaks. Interesting that vegetarianism is such an old compulsion, though.

Even if we concede that getting fat shortens your life, what right has anybody got to question someone's decision to accept that tradeoff for themselves? Such a decision could be just one version of the old idea that it is best to have a short life but a merry one. Even the Bible is supportive of that thinking. See Ecclesiastes 8:15 and Isaiah 22: 13. To deny the right to make such a personal decision is plainly Fascistic.

Obesity does NOT causes diabetes. But insatiable eating is a prominent symptom of diabetes. So diabetes DOES cause obesity, which accounts for the correlation between the two things. The streets are full of fatties who don't have diabetes. How come? If conventional medical theory were correct we should be in the midst of an epidemic of diabetes. A recent high quality study has also found that fatties are LESS likely to die of diabetes

Elite people frequently express disapproval of red meat eating as a way of expressing their felt superiority to the ordinary people who eat it

IQ: Political correctness makes IQ generally unmentionable so it is rarely controlled for in epidemiological studies. This is extremely regrettable as it tends to vitiate findings that do not control for it. When it is examined, it is routinely found to have pervasive effects. We read, for instance, that "The mother's IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status, smoking, the home environment, or the child's birth weight or birth order". So political correctness can render otherwise interesting findings moot

"To kill an error is as good a service as, and sometimes better than, the establishing of a new truth or fact" -- Charles Darwin

"Most men die of their remedies, not of their diseases", said Moliere. That may no longer be true in general but there is still a lot of false medical "wisdom" around that does harm to various degrees -- the statin and antioxidant fads, for instance. And showing its falsity is rarely the problem. The problem is getting people -- medical researchers in particular -- to abandon their preconceptions

Bertrand Russell could have been talking about today's conventional dietary "wisdom" when he said: "The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible.”

The challenge, as John Maynard Keynes knew, "lies not so much in developing new ideas as in escaping from old ones".

"Obesity" is 77% genetic. So trying to make fatties slim is punishing them for the way they were born. That sort of thing is furiously condemned in relation to homosexuals so why is it OK for fatties?

****************

Some more problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize dietary fat. But Eskimos living on their traditional diet eat huge amounts of fat with no apparent ill-effects. At any given age they in fact have an exceptionally LOW incidence of cardiovascular disease. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). And how odd it is that we never hear of the huge American study which showed that women who eat lots of veggies have an INCREASED risk of stomach cancer? So the official recommendation to eat five lots of veggies every day might just be creating lots of cancer for the future! It's as plausible (i.e. not very) as all the other dietary "wisdom" we read about fat etc.

10). And will "this generation of Western children be the first in history to lead shorter lives than their parents did"? This is another anti-fat scare that emanates from a much-cited editorial in a prominent medical journal that said so. Yet this editorial offered no statistical basis for its opinion -- an opinion that flies directly in the face of the available evidence.

11). A major cause of increasing obesity is certainly the campaign against it -- as dieting usually makes people FATTER. If there were any sincerity to the obesity warriors, they would ban all diet advertising and otherwise shut up about it. Re-authorizing now-banned school playground activities and school outings would help too. But it is so much easier to blame obesity on the evil "multinationals" than it is to blame it on your own restrictions on the natural activities of kids

12. Fascism: "What we should be doing is monitoring children from birth so we can detect any deviations from the norm at an early stage and action can be taken". Who said that? Joe Stalin? Adolf Hitler? Orwell's "Big Brother"? The Spanish Inquisition? Generalissimo Francisco Franco Bahamonde? None of those. It was Dr Colin Waine, chairman of Britain's National Obesity Forum. What a fine fellow!

*********************

Trans fats: For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.

The "antioxidant" religion: The experimental evidence is that antioxidants SHORTEN your life, if anything. Studies here and here and here and here and here and here and here and here, for instance. That they are of benefit is a great theory but it is one that has been coshed by reality plenty of times.

The medical consensus is often wrong. The best known wrongheaded medical orthodoxy is that stomach ulcers could not be caused by bacteria because the stomach is so acidic. Disproof of that view first appeared in 1875 (Yes. 1875) but the falsity of the view was not widely recognized until 1990. Only heroic efforts finally overturned the consensus and led to a cure for stomach ulcers. See
here and here and here.

Dieticians are just modern-day witch-doctors. There is no undergirding in double-blind studies for their usual recommendations

The fragility of current medical wisdom: Would you believe that even Old Testament wisdom can sometimes trump medical wisdom? Note this quote: "Spiess discussed Swedish research on cardiac patients that compared Jehovah's Witnesses who refused blood transfusions to patients with similar disease progression during open-heart surgery. The research found those who refused transfusions had noticeably better survival rates.

Medical wisdom can in fact fly in the face of the known facts. How often do we hear reverent praise for the Mediterranean diet? Yet both Australians and Japanese live longer than Greeks and Italians, despite having very different diets. The traditional Australian diet is in fact about as opposite to the Mediterranean diet as you can get. The reverence for the Mediterranean diet can only be understood therefore as some sort of Anglo-Saxon cultural cringe. It is quite brainless. Why are not the Australian and Japanese diets extolled if health is the matter at issue?

Since many of my posts here make severe criticisms of medical research, I should perhaps point out that I am also a severe critic of much research in my own field of psychology. See here and here

This is NOT an "alternative medicine" site. Perhaps the only (weak) excuse for the poorly substantiated claims that often appear in the medical literature is the even poorer level of substantiation offered in the "alternative" literature.

I used to teach social statistics in a major Australian university and I find medical statistics pretty obfuscatory. They seem uniformly designed to make mountains out of molehills. Many times in the academic literature I have excoriated my colleagues in psychology and sociology for going ga-ga over very weak correlations but what I find in the medical literature makes the findings in the social sciences look positively muscular. In fact, medical findings are almost never reported as correlations -- because to do so would exhibit how laughably trivial they generally are. If (say) 3 individuals in a thousand in a control group had some sort of an adverse outcome versus 4 out of a thousand in a group undergoing some treatment, the difference will be published in the medical literature with great excitement and intimations of its importance. In fact, of course, such small differences are almost certainly random noise and are in any rational calculus unimportant. And statistical significance is little help in determining the importance of a finding. Statistical significance simply tells you that the result was unlikely to be an effect of small sample size. But a statistically significant difference could have been due to any number of other randomly-present factors.

"The modern literature on hate crimes began with a remarkable 1933 book by Arthur Raper titled The Tragedy of Lynching. Raper assembled data on the number of lynchings each year in the South and on the price of an acre's yield of cotton. He calculated the correlation coefficient between the two series at -0.532. In other words, when the economy was doing well, the number of lynchings was lower.... In 2001, Donald Green, Laurence McFalls, and Jennifer Smith published a paper that demolished the alleged connection between economic conditions and lynchings in Raper's data. Raper had the misfortune of stopping his analysis in 1929. After the Great Depression hit, the price of cotton plummeted and economic conditions deteriorated, yet lynchings continued to fall. The correlation disappeared altogether when more years of data were added."

So we must be sure to base our conclusions on ALL the data. But in medical research, data selectivity and the "overlooking" of discordant research findings is epidemic.

The Truth About Ancel Keys. Keys was a brilliant man but his concentration on heart disease misled him. He was right that high fat intake predicted high rates of heart disease (though it was ANIMAL fat in particular that was the "culprit") but he overlooked that the same intake predicted LESS mortality from other causes. The same narrow vision led him to be the earliest prominent advocate of the "Mediterranean diet" hypothesis. It's true that Mediterraneans have less heart disease but they have more of other causes of death, so that Mediterranean countries do not have particularly long lifespans when compared with other developed countries. If there are any lessons about diet to be learned from lifespans, it is un-Mediterranean countries like Australia and the Nordic countries that one should look to.

The intellectual Roman Emperor Marcus Aurelius (AD 121-180) could have been speaking of the prevailing health "wisdom" of today when he said: "The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane."

Improbable events do happen at random -- as mathematician John Brignell notes rather tartly: "Consider, instead, my experiences in the village pub swindle. It is based on the weekly bonus ball in the National Lottery. It so happens that my birth date is 13, so that is the number I always choose. With a few occasional absences abroad I have paid my pound every week for a year and a half, but have never won. Some of my neighbours win frequently; one in three consecutive weeks. Furthermore, I always put in a pound for my wife for her birth date, which is 11. She has never won either. The probability of neither of these numbers coming up in that period is less than 5%, which for an epidemiologist is significant enough to publish a paper.

Kids are not shy anymore. They are "autistic". Autism is a real problem but the rise in its incidence seems likely to be the product of overdiagnosis -- the now common tendency to medicalize almost all problems.

One of the great pleasures in life is the first mouthful of cold beer on a hot day -- and the food Puritans can stick that wherever they like

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here